One of the primary goal of the World Health
Organization (WHO) is to rid the world of polio. Some fear that the
time to eradicate the disease may be now--or never. When
WHO first declared war on
polio, forming the Polio Eradication Initiative with partners
Rotary International, the Centers for Disease Control and Prevention, and
UNICEF (the United Nations Children's Fund) in 1988, there were
approximately 350,000 cases of polio in 125 countries on five
continents. After an international investment of U.S.$3 billion and the
combined efforts of 20 million volunteers in more than 200 countries,
just under 700 new cases were reported in 2003, and polio remains
endemic in only 6 countries. Yet ultimate victory is at risk.
Polio begins as an intestinal
virus. Its usual victims are young children living in unhygienic
surroundings, drinking contaminated water. Not everyone who ingests the
virus becomes seriously ill; in fact, most have relatively minor
flu-like symptoms or none at all. Only the unlucky ones become paralyzed and, in some cases, die.
The original goal of the Polio Eradication
Initiative was to wipe out polio worldwide by the year 2000--a goal that
proved overly ambitious for several reasons. Polio is not easy to
diagnose; many who have it display few signs of illness yet remain
contagious for several weeks after all symptoms are gone, and the virus
itself can live outside the human body for up to 60 days. By the time
one case of polio is confirmed, a multitude of others may be incubating,
so that a large number of children over a wide geographic area must be
vaccinated in response to a single confirmed case. In addition one
vaccination may not be sufficiently prophylactic; a child with an intestinal upset may pass the
vaccine through his or her system too quickly for it to be effective. Therefore, repeat vaccinations of all children are necessary.
The cornerstones of the eradication initiative have
been national immunization days, during which all young children in a
target country are vaccinated whether or not they have been vaccinated
before, and immediate response to actual outbreaks, targeting all
children under the age of five in the surrounding area for immunization.
WHO provides the expertise, UNICEF provides the vaccine, Rotary
International provides local advertising and support, and government
health officials arrange for the necessary thousands of trained
vaccinators. In a representative response to a reported case in
Karnataka,
India, 4 million children in 13 districts were vaccinated in three days.
At the start of 2007, polio remained endemic only in India,
Pakistan,
Afghanistan, and
Nigeria, with Nigeria representing over 70% of the total number of
cases reported worldwide in 2006. The spread of the disease to areas
that have reported no cases of infection in recent years is a major
concern, because many countries that had eliminated the disease ended
their routine immunization programs in order to redirect their limited
financial resources to more critical health concerns. Hence the urgency
in WHO's push to wipe out the disease once and for all.
The high incidence of polio outbreaks in Nigeria
has been traced to the northern state of Kano. Muslim leaders in the
area opposed the immunization, in the belief that the vaccine contained
hormones that would sterilize the area's female population. As this
erroneous information circulated, some parents refused to have their
children immunized, and the incidence of new polio cases multiplied. The
Nigerian government, however, has confirmed its trust in the purity of
the UNICEF-provided vaccine and has publicly reasserted its commitment
to the eradication of polio through immunization campaigns. Now it must
convince Kano's state and local governments to support that commitment.
The final phase of polio eradication consists of
three steps: containment of the remaining chains of polio transmission,
certification by independent experts of transmission interruption region
by region (and ultimately, worldwide), and development of
postcertification policies (determining if there is the need for
continuing immunization). Realization of WHO's goal will require the
dedicated efforts of government officials in the nations where polio
remains endemic and continuing financial help from wealthy nations,
several of which have already pledged their assistance. The complete
eradication of polio will save millions of children from a devastating
disease and will also demonstrate the miracles attainable through global
cooperation. The legacy of the world's largest health initiative will
include valuable lessons in the fight against other vaccine-preventable
diseases, and its success will provide confidence that other, even
larger, battles can be won in the 21st century.
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